Family Planning Aid Drops in Priority

Funding for population and reproductive healthcare programs, as a share of global health aid, declined from 30 percent in 1994 to 12 percent last year, according to a new World Bank analysis.

The proportional decrease is due to larger attention in recent years - politically and financially - to other global healthcare crises, particularly HIV/AIDS, tuberculosis, and malaria.

The United Nations Population Fund (UNFPA) released the World Bank statistics last week in advance of World Population Day, which is observed tomorrow. Joy Phumaphi, the Bank's vice president for human development, said that greater financial resources are necessary to help women in developing countries avoid raising families that are larger than they can manage.

"Even before this [economic] crisis began, family planning and reproductive health had fallen off the radar of low-income countries, aid donors, and development agencies," said Phumaphi, a former health minister for Botswana, in a statement. "We've lost precious time in helping women get access to these vital health services, and helping countries get on a faster track to reducing poverty."

Although donor-country governments and international aid agencies are allocating a smaller share of their budgets to family planning services, overall aid for population and reproductive health increased from $901 million in 1995 to $1.9 billion in 2007, the World Bank said.

Yet these increases are small compared to global development aid for health generally. Spending jumped from $2.9 billion in 1995 to $14.1 billion in 2007, according to the World Bank. Much of this increase is attributed to shifting priorities in the United States, the world's largest aid donor.

Between 2001 and 2008, U.S. State Department programs for global health increased spending by nearly 350 percent. Former U.S. President George W. Bush allocated $18.8 billion to various agencies aimed at fighting HIV/AIDS, tuberculosis, and malaria.

The increased funding has not necessarily benefited population and family planning programs, however. "Essentially there have been no big increases for family planning. It becomes a smaller and smaller share of the total," said Ruth Levine, vice president for programs and operations at the Washington, D.C.-based Center for Global Development. "The airtime of political will and political capital really has been devoted to HIV/AIDS."

Healthcare advocates insist that developing countries will require greater levels of assistance in order to meet the United Nations' Millennium Development Goals, targets for reducing poverty, expanding healthcare, and protecting the environment.

Among the targets is universal access to reproductive health by 2015. Based on health surveys, at least 200 million married women who do not currently use contraception would do so to prevent or delay pregnancy if they had access to trusted forms of contraception and counseling on how to use it.

Avoiding unintended pregnancies helps reduce population growth rates that are unsustainable, the UN notes. With more people, consumption levels rise, greenhouse gas emissions increase, and already-depleted resources are further stressed. The world is projected to be home to 9.3 billion people by mid-century unless fertility rates decline more sharply than most demographers expect.

AIDS treatment collects greater attention

Efforts to treat the global AIDS epidemic have resulted in numerous successes in recent years, but despite the significant funding for AIDS-related programs, the number of infections worldwide continues to rise. The UN estimates that by 2007 nearly 3 million people in low- and middle-income countries received antiretroviral treatments to limit HIV infections. Some 70 percent of infected individuals lack access to these drugs.

Skip Moskey, public affairs director of the Global AIDS Alliance Fund, said his campaign advocates for increased spending on healthcare aid in the developing world - not only for HIV/AIDS treatment, but for family planning and population programs as well.

"There have to be resources for all these things," Moskey said. "We can't let them compete against each other."

Still, AIDS treatment may continue to compete with other health issues for limited financial resources. The Center for Global Development estimates that U.S. international AIDS spending, now $2 billion each year, may reach $12 billion by 2016 to treat patients who have become resistant to cheaper antiretroviral drugs. By then, AIDS treatments would consume half of the U.S. foreign assistance budget.

U.S. pressured to increase global aid

After the Bush administration repealed funding for the UNFPA in 2002, U.S. President Barack Obama allotted $50 million to the agency within his first two months in office. Obama pledged during his campaign to double total U.S. foreign aid, but the economic recession may have tempered his administration's willingness to follow through. His Fiscal Year 2010 budget requests $63 billion for global health for the next six years, an increase of $459 million.

The Institute of Medicine, a body of the U.S. National Academies, recommended in May that the United States increase its spending on global health to $15 billion annually by 2012. An expert committee recommended that $3.4 billion be allocated to children and women's health, nutrition, and family planning and reproductive health, "all of which have been severely under-resourced during the past decade," the committee said.

Responding to concerns that population programs may be overlooked, development agencies are seeking ways to integrate reproductive health and HIV/AIDs efforts, Levine said.

"Both are dealing with generally young and reproductive-age people. Women are the focus of attention. It's talking about sex. Seems like we should be talking about [reproductive health and AIDS] together," said Levine, who formerly worked as a World Bank health economist. "The jury is still out on whether or not that integration makes HIV and family planning programs more effective. It seems like it should, but no research says it does."

UN Secretary-General Ban ki-Moon said in his World Population Day message that the economic crisis may lead to greater numbers of women dropping out of school or losing a job. Ban said that funding population and family planning programs may avoid unintended and unsafe pregnancies.

"Investing in girls' education delivers well-known returns," Ban said. "When girls are educated, they are more likely to earn higher wages and obtain better jobs, to have fewer and healthier children and to enjoy safer childbirth."

Ben Block is a staff writer with the Worldwatch Institute. He can be reached at bblock@worldwatch.org.